Everything You Ever Wanted to Know About an HSG

Monday was my HSG. I’d been warned by countless people that this particular procedure hurt like… well, a ‘hopefulmother-fucker’. I’d heard horror stories of people screaming, describing it as the most painful procedure there is. Only a few people didn’t experience excruciating pain.  With my high pain threshold, I thought I would be the exception.  I mean, I was sure it hurt a little, but how bad could it be?

I did some research online.  It looked like all the medical articles acknowledged “some discomfort” and that’s what made me pause. I remembered how the nurse practitioner I saw who performed my first fateful ultrasound said that “miscarrying is like a really bad period.” And as anyone who has *actually* miscarried knows, that is a boldfaced fucking lie.

When I was miscarrying, I had contractions every minute. DH timed them. He made notes, some of which quote me gasping in excruciating pain: It feels like my ovaries are going to explode is the one which still makes me shudder. And I bled so much it was frightening. The pain and the bleeding lasted for 8 days, and I was an emotional wreck. On the bright side, should I ever be so lucky to carry a baby to term, I’m pretty sure I could do it without an epidural. Twelve hours of labour when you’re happily looking forward to finally meeting your baby seems like a walk in the park by comparison. Hopefully one day I’ll be able to say so definitively.

So I took the advice given to me and began taking 600mg of ibuprofen every 6-8 hours starting the night before, along with my first dose of doxycycline (antibiotic).  Monday morning I took my second dose of antiobiotic and ibuprofen, and — oops — only 3 hours later a third dose of ibuprofen.  The point is, I was well and truly ibuprofened up the wazoo by the time my 2pm appointment rolled around.

Two nurses collected me. One, older and Russian, asked me Do yeu knoh vot kaint off prossidure yeu are hevving? I flashed her a grin. Yeah. A horrible one. All joking aside, she concurred.  We entered the HSG room where I saw this:

Those looked like comfortable stirrups, which could only mean one thing: major discomfort elsewhere. I began to joke around, my coping mechanism for when things get a little scary.

After I changed into a gown, I approached the instruments table:

I don’t even know what most of that stuff is but I’ll make a semi-educated guess: the blue sponges on lollipop sticks were to swab my cervix with iodine to sterilize it–because something sure felt like a toothbrush up in my hooha. And I assume the green hose is what gets inserted into the uterus to fill it up with the iodine.

The Russian nurse walked through the procedure — one thing I learned that I didn’t read anywhere / wasn’t told by anyone was how the table actually tips you so your hips are higher than your head, and that you have to roll onto both sides to swill the dye around like a fine wine… She also showed me this helpful diagram:

A resident introduced himself as Dr. K and asked if it was okay for him to be there. I said, Sure, that’s why I’m at a teaching hospital. (It has been my first- and second-hand experience that you get better care at teaching hospitals: the enthusiasm for the subject matter and the recent acquisition of medical knowledge means more questions are asked, which translates to better care.)

And then Dr. R, chief of radiology walked in with her iPhone and speakers. Despite the gentle bluegrass a-twanging, I didn’t think to make any Deliverance jokes at the time. Just as well. Besides, Dr. R was utterly charming and told me that HSGs hurt a lot but that the pain, intense though it was, would only last 90 seconds. And then it was showtime.

The first part of the procedure was like a regular pelvic exam — except you’re lying on a diaper sheet and your legs are being supported by comfortable knee holders. Like I said, having your cervix swabbed with disinfectant feels like a toothbrush.  It doesn’t hurt, but it ain’t fun either. Dr. R made conversation. So, how did you two meet? I love hearing these stories. Did you meet over here or in the UK? I listened as DH told her, No, we met in Paris… and listened to our love story. (It’s a good one — for another time.)

DH moved to stand by my head, as instructed by Dr. R. She gave me fair warning: Okay, raise your arms above your head and hold DH’s hands tight. I complied. DH whispered, Just squeeze my hands. I did.

Having a cannula threaded through your cervix is pretty hideous. It feels unnatural and it hurts. But the part with the excruciating dye is something of a blur. I know there’s a balloon that gets inflated in the uterus to prevent dye from exiting through the vagina. I heard myself cry out. I hung on to DH’s hands for dear life. The iodine dye is a searing pain you cannot imagine. Just when I thought the pain couldn’t get worse, I began roaring as the waves of pain hit me. I remembered my conversation with Lisette from Project Sweet Pea in London — that she could hear the person before her shrieking.

I could hear Dr. R’s brisk instructions, Take your legs out of the stirrups… The table is tipping… Roll onto your right… Roll onto your left… And I could hear DH telling me to breathe into my belly. I shook my head wildly. I tried to focus on his voice, You’re doing great, baby, you’re doing great, and an image-thought flashed across my brain: that this pain was slightly different to labouring in my miscarriage, but it was just as intense and primal. And I knew then, as I had always imagined, that DH would be a terrific birth partner should our time ever come.

Twenty seconds! shouted Dr. R. And then it was over. The table was tipped parallel to the floor and I watched anxiously as Drs. K and R looked at the results. And I got my first piece of good news in a while: no blockages.

I lay shaking on the table.  I tend to shake with adrenaline when I’ve experienced something traumatic — pain or fear or anger. I felt a little light-headed, so the Russian nurse brought me some orange juice, and the Latina nurse patted my legs to comfort me. Dr. R brightly said The good news is that 27% of patients experience heightened fertility after an HSG, even when there was no blockage. DH and I sighed and told her our situation was a little different. We didn’t go into details but explained that we needed IVF. Oh you poor things, she murmured. Then she added, Eat a diet rich in whole grains and vegetables, avoid dairy, take lots of flaxseed, and avoid salmon! I really liked her.

Restored, I sat up. Dr. R instructed me to hold the diaper pad between my legs as the iodine would “gush out, like a period.” I swung my legs off the table, crotch only partially hidden by the diaper pad. This is soooo glamorous! I chuckled. Lovely Dr. R led me to the bathroom and showed me where the sanitary towels were. And then, to my astonishment, she pulled down a lavatory seat cover and place it on the loo for me. I couldn’t believe it, I wouldn’t have expected a nurse to show me such care. I could have hugged her. But after I got dressed and was leaving, I hugged both the nurses. I told them they were both so kind. The Russian nurse said, Ey hop the negz taim we see yeu eet vil be for en ultrasound. And I shared with her one of my favourite Eastern European sayings: From your lips to God’s ears.

We walked to the car slowly.  I was tender and bloated. I really felt like I had just experienced something physically very traumatic, but I was already having a hard time describing the pain to DH. The mind/body is good like that. As for the ibuprofen, fat lot of good that did me, pain-wise. Maybe it helped with the swelling, but I was pretty tender for the next 36 hours.  Even the following day it hurt to walk — it might sound crazy, but I could literally feel my cervix jolting around. Strangely, not much iodine came out of me. I guess my tubes must be really open or something, because I barely needed a pantyliner.

In spite of the jolting and the bloating, I was comforted: My tubes are okay. My ovaries may be a bit fucked, but my tubes are okay. Although fallopian tubes are bypassed when you do IVF, it’s important to not have any blockages because a blockage can compromise the uterine environment (if something is trapped in the tube, it will leak into the womb). Hopefully the saline sonohysterogram I’ll have in a couple of weeks will show that my uterine lining is good, that I don’t have any scarring from my D&C.

I pushed my worries aside and focused on a single thought: I’ve had good news. I’ve had good news. Finally, I’ve had some good news.